title: Separate goals, converging priorities: on the ethics of treatment as prevention.
abstract: Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic? Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs.
authors.affiliation: School of Public Policy, University College London.
authors.forename: Florian
authors.initials: F
authors.lastname: Ostmann
authors.forename: Carla
authors.initials: C
authors.lastname: Saenz
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D018562:Disease Transmission, Infectious / Q000941:ethics / Q000517:prevention & control; D005260:Female; D006040:Goals; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D015276:Health Care Rationing / Q000941:ethics*; D006292:Health Priorities / Q000941:ethics*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000941:ethics / Q000517:prevention & control; D008297:Male; D011322:Primary Prevention / Q000941:ethics* / Q000379:methods
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; antiretroviral therapy; bioethics; prevention; priority setting; treatment; treatment as prevention